PMID- 37283159
OWN - NLM
STAT- MEDLINE
DCOM- 20230608
LR  - 20230614
IS  - 2078-5135 (Electronic)
VI  - 113
IP  - 4
DP  - 2023 Apr 4
TI  - The incidence and outcomes of high-risk acute coronary syndromes in the Western 
      Cape Province of South Africa: a prospective cohort study.
PG  - 24-25
AB  - Tygerberg Hospital (TBH) is a tertiary level hospital in the Western Cape of 
      South Africa that serves a large, low to middle income population with 
      centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an 
      important cause of death in the region, despite a high burden of communicable 
      diseases, including people living with human immunodeficiency virus (PLHIV).   
      Objectives. We sought to describe the incidence of ST elevation myocardial 
      infarction (STEMI) and high-risk non-ST elevation ACS (HR-NSTEACS) in the TBH 
      referral network, describe the in-hospital and 30-day mortality of these patients 
      and identify important high-risk population characteristics.  Methods. The 
      Tygerberg Acute Coronary Syndrome Registry (TRACS) database is an ongoing 
      prospective study that enrols all STEMI and HR-NSTEACS patients in the TBH 
      referral network. All patients older than 18 years presenting with STEMI or 
      HR-NSTEACS were treated in accordance with current European Society of Cardiology 
      (ESC) guidelines and were included prospectively over a 9-month surveillance 
      period. A waiver of consent was granted to include patients who demised prior to 
      giving informed consent. Collected data included a demographic profile, risk 
      factors for cardiovascular disease, in hospital therapy and 30-day mortality.  
      Results. A total of 586 patients were enrolled, with a male predominance (64.5%) 
      and incidence rates of STEMI and HR-NSTEACS of 14.7/100 000 and 15.6/100 000 
      respectively.  The mean patient age was 58.1 years and STEMI patients tended to 
      be younger than HR-NSTEACS patients (56yrs vs.58yrs; p=0.01). Cardiovascular risk 
      factors were prevalent overall, but hypertension (79.8%vs.68.3%; p<0.01), and 
      pre-existing coronary artery disease (29%vs.7%; p=0.03) were more prevalent in 
      the HR-NSTEACS group.  HIV was present in 12.6% of patients tested, similar to 
      the background population rate. The overall 30-day all-cause mortality was 6.1% 
      with an in-hospital mortality rate of 3.9%. The 30-day mortality rates were 
      similar for STEMI (6.7%) and HR-NSTEACS (5.7%; p=0.83).  PLHIV did not impact 
      mortality.   Conclusions. The use of a guideline-based approach to treating ACS 
      in a low-middle income countries (LMIC) setting yields mortality rates comparable 
      to high income countries. However, the lower-than-expected incidence rates of 
      both STEMI and NSTEACS in a relatively young population with a high prevalence of 
      traditional cardiovascular risk factors, and relatively high proportion of STEMI, 
      suggests potential under recording of ischemic heart disease (IHD) in the 
      region.  The rate and outcomes of coronary artery disease (CAD) in PLHIV was 
      similar to people without HIV, suggesting that traditional risk factors still 
      drive CAD outcomes in the region.
FAU - Cilliers, J
AU  - Cilliers J
AD  - Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape 
      Town, South Africa. jdcilliers123@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20230404
PL  - South Africa
TA  - S Afr Med J
JT  - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
JID - 0404520
SB  - IM
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Female
MH  - *Acute Coronary Syndrome/epidemiology/therapy
MH  - Prospective Studies
MH  - *Myocardial Infarction
MH  - *Coronary Artery Disease
MH  - Incidence
MH  - *ST Elevation Myocardial Infarction
MH  - South Africa/epidemiology
MH  - Risk Factors
MH  - *HIV Infections/epidemiology
EDAT- 2023/06/07 06:42
MHDA- 2023/06/08 06:42
CRDT- 2023/06/07 05:44
PHST- 2023/03/06 00:00 [received]
PHST- 2023/06/08 06:42 [medline]
PHST- 2023/06/07 06:42 [pubmed]
PHST- 2023/06/07 05:44 [entrez]
PST - epublish
SO  - S Afr Med J. 2023 Apr 4;113(4):24-25.